How does psychotherapy work?
Successful treatment is the result of three factors working together:
- Evidence-based treatment that is appropriate for your problem.
- The psychologist’s clinical expertise.
- Your characteristics, values, culture and preferences.
When people begin psychotherapy, they often feel that their distress is never going to end. Psychotherapy helps people understand that they can do something to improve their situation. That leads to changes that enhance healthy behavior, whether it’s improving relationships, expressing emotions better, doing better at work or school, or thinking more positively. This is very empowering! While some issues and problems respond best to a particular style of therapy, what remains critical and important is the therapeutic relationship with your psychologist. Keep in mind that as psychotherapy progresses, you may feel overwhelmed. You may feel more angry, sad or confused than you did at the beginning of the process. That doesn’t mean psychotherapy isn’t working. Instead, it can be a sign that therapy is causing you to confront difficult truths or do the hard work of making changes. In such cases, these strong emotions are a sign of growth rather than evidence of a standstill. Remember, sometimes things may feel worse before they get better.
How long should psychotherapy take?
How long psychotherapy takes depends on several factors: the type of problem or disorder, the patient’s characteristics and history, the patient’s goals, what’s going on in the patient’s life outside psychotherapy and how fast the patient is able to make progress.
Some people feel relief after only a single session of psychotherapy. Meeting with a psychologist can give a new perspective, help them see situations differently and offer relief from pain. Most people find some benefit after a few sessions, especially if they’re working on a single, well-defined problem and didn’t wait too long before seeking help.
If you’ve been suffering from extreme anxiety, for example, you might feel better simply because you’re taking action — a sign of hope that things will change. Therapy might also offer a fresh perspective early in your treatment that gives you a new understanding of your problem. And even if your problem doesn’t go away after a few sessions, you may feel confident that you’re already making progress and learning new coping skills that will serve you well in the future.
Other people and situations take longer — maybe a year or two — to benefit from psychotherapy. They may have experienced serious traumas, have multiple problems or just be unclear about what’s making them unhappy. It’s important to stick with psychotherapy long enough to give it a chance to work.
People with serious mental illness or other significant life changes may need ongoing psychotherapy. Regular sessions can provide the support they need to maintain their day-to-day functioning. Others continue psychotherapy even after they solve the problems that brought them there initially. That’s because they continue to experience new insights, improved well-being and better functioning.
Psychotherapy: Myths versus reality
If what you know about psychotherapy comes from TV or the movies, you may have some misguided notions about what goes on in a practicing psychologist’s office. Make sure you know the reality instead of the myths so you can benefit from all that psychotherapy has to offer.
Myth #1: Only crazy people go to psychotherapy.
Untrue. People seek psychotherapy for a range of reasons in everyday life. Some pursue psychotherapy for treatment of depression, anxiety or low self-esteem. But others want help coping with major life transitions or changing problem behaviors: the loss of a job, a divorce or the death of a loved one. Yet others need help managing and balancing the demands of parenting, work and family responsibilities, coping with medical illness, improving relationship skills or managing other stressors that can affect just about all of us. Anyone can benefit from psychotherapy to become a better problem solver.
Stigma connected to getting help for psychological or behavioral concerns used to be a strong deterrent for people. But getting help is now seen as a sign of resourcefulness. Researchers continue to find new links emphasizing the value of taking care of mental health to ensure good physical health, often called the mind-body health connection. Emotional problems can show up as physical symptoms. And when we are physically ill, we may develop emotional issues. Even the federal government recently recognized the value of mental health treatment with its passage in 2008 of the mental health parity law.
Psychotherapy Myth #2: Talking to family members or friends is just as effective as going to a psychologist.
Support from family and friends you can trust is important when you’re having a hard time. But a psychologist can offer much more than talking to family and friends. Psychologists have years of specialized education, training and experience that make them experts in understanding and treating complex problems. And research shows that psychotherapy is effective and helpful. The techniques a psychologist uses during psychotherapy are developed over decades of research and more than “just talking and listening.”
Psychologists can recognize behavior or thought patterns objectively, more so than those closest to you who may have stopped noticing — or maybe never noticed. A psychologist might offer remarks or observations similar to those in your existing relationships, but the help may be more effective due to timing, focus or your trust in their neutral stance.
Plus, you can be completely honest with me without concern that anyone else will know what you revealed. The therapeutic relationship is grounded in confidentiality. (There are a few exceptions where a psychologist has a duty to inform others, such as if you threaten to harm yourself or someone else. But that’s something I will clarify and discuss with you.) In fact, people often tell their psychologists things they have never before revealed to anyone else. If your difficulties have been ongoing without any significant improvement, it may be time to seek help from a trained psychologist.
Psychotherapy Myth #3: You can get better on your own if you just try hard enough and keep a positive attitude.
Many people have tried to solve their problems on their own for weeks, months or even years before starting psychotherapy but have found that that it’s not enough. Deciding to start psychotherapy doesn’t mean you’ve failed, just like it doesn’t mean you’ve failed if you can’t repair your own car. There may be a biological component to some disorders, such as depression, eating disorders, or panic attacks, which make it incredibly difficult to heal yourself. In reality, having the courage to reach out and admit you need help is a sign of strength rather than weakness — and the first step toward feeling better.
Psychotherapy Myth #4: Psychologists just listen to you vent, so why pay someone to listen to you complain?
A psychologist will often begin the process of psychotherapy by asking you to describe the problem that has brought you into his or her office. But that’s just psychotherapy’s starting point. I will also gather relevant information on your background, as well as the history of your problems and other major areas of your life, and the ways you have tried to address the concerns. Psychotherapy is typically an interactive, collaborative process based on dialogue and the patient’s active engagement in joint problem-solving.
I may give you homework assignments so that you can practice new skills between sessions or reading assignments so that you can learn more about a particular topic. Together you and I will identify problems, set goals and monitor your progress.
Psychotherapy Myth #5: Psychologists just blame all your problems on your parents or your childhood experiences.
One component of psychotherapy might entail exploring childhood experiences and significant events impacting your life. Relating information from your family background can help you and me understand your perceptions and feelings, current coping strategies, or see patterns that developed. The point of wanting you to look backward is to better understand your present and make positive changes for the future.
However, in some instances I will choose to focus mainly on the current problem or crisis that brought you into treatment and not delve into your past at all. You’ll learn how to incorporate techniques and use tools that will help change your current thoughts or behaviors contributing to your problem. Psychologists who use an eclectic style of psychotherapy (like I do) know how to guide the session to include discoveries about your past with reflections on current problematic thoughts or behaviors.
Psychotherapy Myth #6: You’ll need to stay in psychotherapy for many years or even the rest of your life.
Everyone moves at a different pace during psychotherapy — it’s a very individualized process. In one study for example, half of patients in psychotherapy improved after just eight sessions while 75 percent had improved by the six-month point. It’s something you and I talk about in the initial meetings when developing a treatment plan. My goal is to empower you to function well on your own, in your Authentic Self.
Source: American Psychological Association and Elayne Daniels, PhD